I wish all states were mandatory counseling. Do some of you really not counsel your patients when they pick up new medications? Sometimes I wonder about you guys.....I mean, you want us to be taken seriously for our knowledge yet you don't want to put it to use. Either way, I think this is a good thing. It will cut down on misfills and put more responsibility on the dispensing pharmacist.
No, mandatory counseling creates unnecessary interruptions to your workflow. When you're verifying input or products, You can't go 15 seconds straight without an interruption. Then you rush over there only to hear "I've had these for years"
The majority of mistakes -wrong product, wrong directions- are caught at Input verification. For Walgreens, that's "F4", for those who use the McKesson system that's "pre-verification", Walmart 4Point, etc. If an error is not caught at this point, it is unlikely to get caught because it will get filled and if it's filled correctly, it will scan just fine even if it the wrong drug was entered. Then at Visual Verification, most pharmacist are just looking at the pill and don't look at the script. To be fair, most companies do not require that you look at the script again at Visual
Verification as part of their best practices. All those constant interruptions lead to extreme mental fatigue and eventually, you'll make a mistake.
I have seen both sides. Thus, I feel I can speak from first-hand experience. I am licensed in two states; one with mandatory counseling on everything and the second state, has mandatory counseling only on new prescriptions. The pharmacist may also exercise professional judgment and waive the counseling requirement if this "new" prescription is a renewal and there aren't any changes in therapy and if in the professional judgment of the pharmacist the patient has shown adherence and they're fine and will be fine.
In this second state, the pharmacist may have 6 mandatory consults in one day if it's a REALLY busy store. Mistakes rarely ever happen because you aren't interrupted to go Counsel on nothing really because all you're doing is an additional Visual verification, right there in front of the patient, which to me, it may give patients the impression that at moment is when the pharmacist visually verifies the drugs. Some companies require "show and tell" on everything, even refills. The whole frantic display does not look reassuring, by any means.
So in this second state, refills are carefully matched with their paperwork and bags are stapled shut and the state allows the pharmacist to opt those scripts out of mandatory counseling.
The last person to touch that bag is a pharmacist who then staples it shut. Then patient picks up their refills. Offer is made. Then they confirm that "it's just refills". The pharmacist is never dragged into any of this at any point of this perfunctory process.
Now let me tell you how different from that it is in the first state I mentioned. Like I said, the pharmacist has to rush up there and check the vials and basically do a 3rd Visual. The countless times I have run into cr@p in those bags who were last touched by a careless tech or worse a CLERK... And then I have to quickly scramble. I catch a lot of errors because if I'm going to jeopardize my license by dropping everything that I am doing to run over there, I am going to make sure everything in that bag is right. I'm basically that guy that turns on the blinker when switching lanes or making a turn whether I'm the only soul out on the street or not.
Oh and this state with mandatory counseling does not require technicians to be certified. So really? Let's work pharmacists to death and they can do so with unskilled laborers? Sounds great. So you can imagine, that your license is on the line at all times. So you have techs that are NOT CERTIFIED entering prescriptions and they make mistakes left and right. Call them turtles... and they will send trash at you on purpose. They don't care. And then they will summon the "open door policy" and a lot of you know how that goes - when you get "open door-ed".
In the second state, all techs are required to be certified - end of story. If you can't handle that, go back to "grocery" or cashier.
In the second state, whenever I stapled shut that bag, I was ready to let it go for good. But in the first state -where I work now- , I never know what kind of cr@p I am going to find in the bag.
So the board of pharmacy of that first state has failed to see that ultimately, dragging the pharmacist up there is going to lead to more mistakes. And they will only get caught if you're really paying attention. I'd say 55% of the pharmacists I've run into in state #1 are paying attention. The other 45% aren't.
How many job openings each state has tells you a lot about not only the working conditions but also the efficiency of the quality assurance system in place and whether pharmacists are embracing it or not. In other words, do pharmacists want to work there or not? The drive to the other state is literally 20 minutes. It's no big deal. If you really wanted to, you could move closer but why would you go over there to work TWICE as HARD and HALF as SMART. In the second state, you do "double checks". Most companies do overload their pharmacists with piles of California bundles to be checked and initialed within 72 hours of RPH verification. HOWEVER, other companies; i.e., one of them is Walmart, have embraced a paperless system by adding a "double check" queue that done after the final visual verification. It's basically a check on the initial Input verification done by the first pharmacist. You catch a lot of mistakes that way, especially if you are not the only RPH on duty. If you are by yourself, you have to wait 2 hours to do the double check. HOWEVER, if there is an intern or another pharmacist, the double check can be done almost immediately *I think. Often times, when these errors are caught, the bag is still in the Will Call Bin. Thus, no harm done. As opposed to that frantic display at the counseling window.
In state #1, it's very hard to fill retail positions. plenty of jobs to choose from. If you take a job in this state, you're always checking for an opening anywhere across the river.
In state #2, nothing ever opens. Pharmacists know they have it good. They don't get home DRAINED to their families. They are able to do it all over again the next day and get through the day.
One more thing, yes, I share my knowledge to the patient but if it is a true new medication I also gently remind them it's up to them. "Oh, the pharmacist didn't tell me that my epidermis would detach from my dermis if I didn't follow the schedule for this med". None of that nonsense. I open the patient leaflet and tell them "your prescriber wants you to take one twice daily etc. the most common side effect is ......./ food or no food. Make sure you go through this leaflet. This is YOUR GUIDE."
I'm always happy to share and sure, I can show them how to use their Breo Ellipta but given that I have to go up to the consultation window for no reason at all 200 times a day, I keep it succinct and direct them to the manufacturer website which likely has videos or YouTube. I even pull out my phone and walk them how to do it on theirs.
I hope this sheds some light onto why some of us who work in a state with mandatory counseling appear so bent out of shape and burnt out. Of course we all make choices and I'll get out as soon as that is an option.